January 2014 – Surrey Podiatrist: Ankle sprains are the most common condition that foot and ankle doctors see. It is typically an injury of one or more ligaments supporting the ankle joint. Ligaments are a type of tissue that holds bones together. The severity of the sprain is dependent on how many ligaments are injured and whether they are stretched, partially torn, or completely torn. Thus, it’s important to see a foot and ankle specialist promptly to receive medical attention and start rehabilitation.
The controversy involved in treatment centers around severe ankle sprains and the length of time of immobilization (casting or placed into a large boot). The longer the timeframe that a patient is casted, the longer the functional rehabilitation will be. For severe ankle sprains, patient’s can either be immobilized in a cast or short leg boot, or they can start functional rehabilitation with physiotherapy.
Studies have shown that patients who start functional rehabilitation earlier, their time to return to work is shorter, they suffer less swelling and the fewer have instability symptoms1. By contrast, randomized controlled trials have shown a lack of difference between the two treatment strategies, three months after the injury2.
Given these differences in the literature, there are two general schools of thought for treatment of severe sprains. It is reasonable that if a patient has pain with any mobility of the ankle, that he or she should be immobilized for at least 1-2 weeks. Ultimately, one the most important factors guiding a decision in this matter is the question of patient compliance. The better a patient is able to adhere to the treatment plan, the faster they can rehabilitate from an injury.
1.) Kerkhoffs GM, Rowe BH, Assendelft WJ, et al. Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults. Cochrane Database Syst Rev 2002
2.) Lamb SE, Marsh JL, Hutton JL, et al. Mechanical supports for acute, severe ankle sprain: a pragmatic, multicenter, randomized control trial. Lancet 2009; 373-575